Analysis of Radial Peripapillary Capillary Density in Patients with Bietti Crystalline Dystrophy by Optical Coherence Tomography Angiography / 生物医学与环境科学（英文）

OBJECTIVE@#We wanted to investigate the radial peripapillary capillary (RPC) network in patients with Bietti crystalline dystrophy (BCD).@*METHODS@#We compared RPC densities in the disk and different peripapillary regions, obtained using optical coherence tomography angiography in 22 patients with BCD (37 eyes) and 22 healthy subjects (37 eyes). The BCD group was then divided into Stage 2 and Stage 3 subgroups based on Yuzawa staging, comparing the RPC densities of the two.@*RESULTS@#The disk area RPC density was 38.8% ± 6.3% in the BCD group and 49.2% ± 6.1% in the control group ( P < 0.001), and peripapillary region RPC density was significantly lower in the BCD group than in the control group (49.1% ± 4.7% and 54.1% ± 3.0%, respectively, P < 0.001). There were no significant RPC density differences between the tempo quadrant and inside disk of Stages 2 and 3 subgroups; the other areas showed a significantly lower RPC density in Stage 3 than in Stage 2 BCD.@*CONCLUSION@#The BCD group RPC density was significantly lower than the control group. The reduction of RPC density in the tempo quadrant occurred mainly in the Stage 1 BCD. In contrast, the reduction of RPC density in superior, inferior, and nasal quadrants occurred mainly in Stage 2.

Fenómenos vasculares retinianos en esclerosis múltiple. Reporte de caso y revisión narrativa de la literatura / Retinal vascular phenomena in multiple sclerosis. Case report and narrative review of the literatura

Introducción: La esclerosis múltiple (EM) es la enfermedad inflamatoria desmielinizante del sistema nervioso central (SNC) más prevalente en el mundo. Puede presentar afectación a nivel ocular a través del compromiso inflamatorio de distinto tejidos. Objetivo: Dar a conocer la importancia del enfoque temprano de la esclerosis múltiple por parte del médico oftalmólogo. Diseño del estudio: Reporte de caso y revisión narrativa de la literatura. Resumen del caso: Se reporta el caso de una paciente joven con signos de vasculitis retiniana (VR) asociada a neuritis óptica bilateral y uveítis anterior como debut de inusual de la EM. Para la revisión narrativa se llevó a cabo la búsqueda avanzada en tres bases de datos electrónicas: PUBMED, LILACS y OVID. Por medio del gestor de referencias Zotero se realizó la eliminación de duplicados y lectura crítica de título y resumen de 162 artículos por parte de dos investigadores. Conclusión: La EM es una enfermedad crónica inflamatoria del SNC. Puede afectar las estructuras oculares de distintas maneras, una de ellas es la VR, que aunque se caracteriza por el compromiso de vasos venosos, hay que tener en cuenta presentaciones atípicas como hemorragias periarteriolares, aneurismas de grandes vasos, cierre capilar periférico, oclusión de arterial central de la retina, neovascularización del nervio óptico o aparición en etapas tempranas de la enfermedad. La fuerte asociación entre la VR y la actividad de la EM destaca la importancia del reconocimiento de patrones atípicos de una enfermedad que requiere del manejo y seguimiento oportuno por parte de neurología y oftalmología.

Background: Multiple sclerosis (MS) is the most prevalent infl ammatory demyelinating disease of the central nervous system (CNS) in the world. It may present involvement at the ocular level through the inflammatory compromise of different tissues. Objective: To provide knowledge on the importance of the early approach of multiple sclerosis by the ophthalmologist. Study design: Case report and narrative review of the literature. Case summary: We report the case of a young patient with signs of retinal vasculitis (RV) associated with bilateral optic neuritis and anterior uveitis as an unusual debut of MS. For the narrative review, the advanced search was carried out in three electronic databases: PUBMED, LILACS and OVID. Through the Zotero reference manager, the elimination of duplicates and critical reading of the title and summary of 162 articles by two researchers was carried out. Conclusion: MS is a chronic inflammatory disease of the CNS. It can affect the ocular structures in different ways, one of them is RV, which although it is characterized by the involvement of venous vessels, we must take into account atypical presentations such as periarteriolar hemorrhages, large vessel aneurysms,peripheral capillary closure, retinal artery occlusion, neovascularization of the optic nerve or appearance in the early stages of the disease. The strong association between RV and MS activity highlights the importance of recognizing atypical patterns of a disease that requires early management and follow-up by neurology and ophthalmology.

Achados oftalmológicos em pacientes que receberam transplante cardíaco / Ophthalmologic findings in cardiac transplant recipients

OBJETIVO: Avaliar os achados oculares, pelo exame oftalmológico, em indivíduos que receberam transplante cardíaco, buscando especialmente investigar possíveis alterações na camada de fibras nervosas da retina com polarímetro de varredura a laser. MÉTODOS: Foram estudados 15 indivíduos que receberam transplante cardíaco no período de setembro de 2003 a julho de 2004. Todos foram submetidos a exame que constava de acuidade visual para longe (AVL), biomicroscopia, tonometria e fundoscopia. Onze pacientes foram submetidos ao analisador de fibras nervosas GDx. Doze eram do sexo masculino e a média da idade foi de 55,0 ± 13,5 anos. O tempo decorrido desde o transplante variou de 3 a 74 meses, com média de 29,7 ± 20,8 meses. RESULTADOS: A AVL com melhor correção foi igual ou melhor do que 20/40 em todos os pacientes. Em um deles observou-se a presença de catarata subcapsular posterior; em outro, nubéculas na córnea secundárias a quadro de herpes zoster. À fundoscopia pôde-se observar lesão cicatrizada sugestiva de retinocoroidite em um paciente. As alterações observadas à biomicroscopia e à fundoscopia eram esperadas devido à imunossupressão subseqüente ao transplante. Ao GDx observou-se perda de fibras da camada de fibras nervosas da retina superior em 12 dos 22 olhos avaliados. CONCLUSÃO: Os resultados apóiam a suposição de que antes ou durante o transplante cardíaco tenha havido diminuição no aporte de oxigênio à circulação retiniana, levando a perda parcial de fibras da retina.

PURPOSE: To evaluate findings of ophthalmologic examinations in cardiac transplant recipients, searching especially for changes in the retinal nerve fiber layer by means of Scanning Laser Polarimetry. METHODS: Fifteen cardiac transplant recipients were examined from September 2003 to July 2004. All of them underwent ophthalmologic examination, which consisted of visual acuity (VA), biomicroscopy, tonometry and fundoscopy. Fiber layer analyzer - GDx - examination was performed in eleven patients. Twelve patients were men. The mean age was 55.0 ± 13.5 years. The follow-up since transplantation lasted from 3 to 74 months; mean value 29.7 ± 20.8 months. RESULTS: VA with best correction in all patients attained at least 20/40. Subcapsular posterior cataract was seen in one patient; another presented corneal nubeculae secondary to herpes zoster. In one case a scar suggesting retinocoroiditis was seen at fundoscopy. Biomicroscopic and the fundoscopic findings were expected because of immunosuppressive treatment, following transplantation. GDx examination disclosed loss of fibers in the superior retinal fiber layer in 12 of the 22 examined eyes. CONCLUSION: These results support the hypothesis that reduction of oxygen inflow in retinal circulation before or during heart transplantation could lead to loss of fibers in the retinal nerve fiber layer.

The Clinical Significance of Venous Filling Time through Panretinal Photocoagulation in Proliferative Diabetic Retinopathy

PURPOSE: To verify the clinical correlation between retinopathy progression and the change of venous filling time (VFT), measured before and after panretinal photocoagulation (PRP), in proliferative diabetic retinopathy (PDR) patients. METHODS: We conducted this study on 32 patients (32 eyes) who received PRP for PDR. These patients were subdivided into two groups in accordance with the clinical course of PRP: the stabilized group in which retinal neovascularization was regressed and the progressed group in which retinal neovascularization was continued and a complication, such as vitreous hemorrhage or tractional retinal detachment, was developed within 12 months of laser treatment. Arteriovenous passage time (AVP) and VFT were measured by video fluorescein angiogram (FAG) using scanning laser ophthalmoscope (SLO) before and after PRP. VFT values were assigned by measuring by the time duration from start of venous lamina flow to the fullness of fluorescence on the vascular arch. RESULTS: In the stabilized group, AVP was decreased by 0.20+/-0.89sec and VFT was decreased by 0.30+/-1.69 sec through PRP. In the progressed group, AVP was increased in 0.12+/-1.22 sec and VFT was increased by 0.99+/-1.60 sec through PRP. In both groups, the VFT changes were significant (P=0.04) but the AVP changes were not (P=0.34). CONCLUSIONS: VFT was significantly decreased in the stabilized group and significantly increased in the progressed group after PRP. Accordingly, we suggest that VFT changes after PRP can be utilized as a prognostic indicator for evaluating clinical course of diabetic retinopathy after performing PRP and for monitoring the clinical effect of PRP.

Estudio de las alteraciones oftalmoscópicas en la hipertención arterial / Ophtalmoscopic features studied by opthalmoscopy in arterial hypertension

La oftalmoscopía puede proporcionar información del grado de actividad y antigüedad de la hipertensión arterial sistémica. Con el advenimiento de la terapia antihipertensiva, la historia natural de la retinopatía hipertensiva se ha modificado, así como los cuadros oftalmoscópicos que se obserban en la antigüedad (exceptuando las manifestaciones oftalmoscópicas secundarias a hipertensión maligna). Trataremos de correlacionar las variables de edad, sexo y factores causales de hipertensión arterial tales como nefropatía, uropatía. etc., con el grado de actividad y antigüedad de la hipertensión, demostrable en las alteraciones oftalmoscópicas

Amaurosis fugax / Amaurosis fugax

La amaurosis fugax es considerada una ceguera monocular transitoria secundaria a isquemia por embolización o insuficiencia vascular que representa un síntoma de enfermedades sistémicas cuyos mecanismos fisiopatológicos incluyen además trombosis, inflamación vascular, hipotensión o vasoespasmo. Su diagnóstico requiere de estudio de laboratorio e imagen para conocer la causa y algunas veces poder ofrecer tratamiento oportuno a los individuos que presentan estos episodios

Microangiopatía retiniana en el síndrome de anticuerpos antifosfolípido primario. Reporte de un caso / Primary antiphospholipid syndrome and microangiopathy. A case report

Se presenta un caso clínico de una paciente del sexo femenino de 35 años de edad con pérdida brusca de la visión de ojo derecho, sin antecedentes de colangenopatías y clínicamente sana hasta el inicio de su padecimiento. La pérdida de la visión se asoció con una hemorragia en la arteria retiniana de la región temporal, con edema papilar discreto. La fluorangiografía correlacionó con el examen del fondo del ojo. Los estudios de laboratorio mostraron títulos altos de anticuerpos antifosfolípido de clase IgG. Los anticuerpos antinucleares y los estudios de inmunoespecificidad resultaron negativos, al igual que la serología para padecimientos infecciosos. La paciente recibió esteroides y aspirina y progresivamente mejoró el cuadro y los títulos de anticuerpos antifosfolípidos decrecieron después de 45 días de tratamiento. Se presenta este caso como una manifestación del síndrome de antifosfolípido primario

El ojo y la hipertensión arterial / The eye and high-blood pressure

En el presenta trabajo se describen las alteraciones que ocurren en algunas estructuras del órgano de la visión como consecuencia de la hipertensión arterial. No se detalla la correspondencia entre la alteración y tipo de hipertensión. Sólo se expone la descripción de cambios que ocurren en el paciente hipertenso. Las alteraciones de la retina y sus vasos vistas por oftalmoscopia ocupan el centro de esta revisión donde también se aportan algunas experiencias en el campo de la electrofisiología, así como las modificaciones encontradas en la microcirculación de la conjuntiva. Los cambios ocurridos en la retina se separan en 2 grupos y se señala la importancia de estos hallazgos en relación con el diagnóstico precoz, pronóstico y evolución de la hipertensión. Se describen las alteraciones electrofisiológicas en los capilares así como otros cambios menos frecuentes (la reducción del campo visual, la asociación glaucoma: hipertensión arterial y la disminución del sentido cromático)

Significado del pulso venoso espontaneo en la retina / Heaning of the spontaneous venous pulsation in the retina

El hallazgo del pulso venoso espontáneo en una o varias venas retinianas en un porcentaje apreciable de la población mundial, ha sido un fenómeno que se viene estudiando desde finales del siglo pasado. Su etiología ha sido explicada mediante diversas teorías. Con el estudio de la incidencia del pulso venoso espontáneo en pacientes y en la población general, se llegó a comprender su mecanismo de producción, y ha llegado a ser un instrumento clínico de despistaje en el campo de la neuroftalmología. Antes de entrar es su importancia clínica se deben considerar algunos aspectos

ERG b/a ratio and retinal circulation time of CRVO

Fourteen cases of central retinal vein occlusion (CRVO) were studied with electroretinogram (ERG) and fluorescein angiogram. The cases were divided into a venous stasis retinopathy group (VSR,9 cases) and a hemorrhagic retinopathy group(HR, 5 cases). The b/a ratio and retinal circualtion time (RCT) were measured and compared with the control group. The mean b/a ratio of the HR group (0.86) was decreased as compared with the VSR group (1.18) and the control group (1.23). The RCT of the HR group was markedly delayed to 13.68 seconds as compared with the VSR group (11.09 sec) and the control group (6.4 sec). These facts suggest that both the b/a ratio and the RCT are possible parameters for estimating retinal ischemia and that the ERG is a reliable examination method for classification of CRVO.